The title compound, C20H23N3O6S, crystallizes with two crystallographically independent molecules in the asymmetric unit. The thiomorpholine ring in both molecules adopts a chair conformation. The crystal structure is stabilized by C—H⋯O interactions. The amino groups are shielded and, as a result, these groups are not involved in hydrogen bonding.
The coronal cast restoration continues to be used commonly to restore mutilated, endodontically treated teeth. The tensile bond strength of luting cements is of critical importance as many of failures are at the core and the crown interface. An invitro study with aim to evaluate and compare bond strengths of luting cements between different core materials and cast crowns. A total of 45 extracted identical mandibular second premolars were endodontically treated and divided into 3 groups of 15 each. Specimens in first group were restored with cast post and core (Group C), and specimens in second group were restored with stainless steel parapost and composite core material (Group B) and specimens in third group were restored with stainless steel parapost and glass ionomer core build (Group G). Standardized crown preparation was done for all the specimens to receive cast crowns. Each group was further divided into 3 subgroups and were cemented using 3 different luting cements namely, resin cement, polycarboxylate cement, glass ionomer cement (Type I). The samples of each subgroup (n = 5) were subjected to tensile testing using Universal Testing Machine at a crosshead speed of 2 mm/min till the dislodgement of crown from the core surface was observed. The bond strengths were significantly different according one way ANOVA (F-150.76 and p < 0.0000). The results of the study showed that the specimens cemented with resin cement in cast core, composite core and glass ionomer core exhibited significantly higher bond strengths as compared to specimens cemented with glass ionomer and polycarboxylate cement. Composite resin core and resin cement combinations were superior to all other cement and core combinations tested.
Endodontically treated tooth; Post and core; Luting agent; Cast crown; Tensile bond strength
In the crystal of the title compound, C11H12O5S2, molecules are linked by O—H⋯O hydrogen bonds and C—H⋯O interactions, forming a three-dimensional network.
An ‘anal’ fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula.
PRESENTATION OF CASE
A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely.
Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7–26.5%) and a high risk of impaired continence (5–40%).
Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence.
Anal fistula; Limb communication; Ksharasutra
DNA methylation of promoter-associated CpG islands of certain genes may play a role in the development of colorectal cancer. The MYOD-1 gene which is a muscle differentiation gene has been showed to be significantly methylated in colorectal cancer which, is an age related event. However the role of this gene in the colonic mucosa is not understood and whether methylation occurs in subjects without colon cancer. In this study, we have determined the frequency of methylation of the MYOD-1 gene in normal colonic mucosa and investigated to see if this is associated with established colorectal cancer risk factors primarily ageing.
We analysed colonic mucosal biopsies in 218 normal individuals and demonstrated that in most individuals promoter hypermethylation was not quantified for MYOD-1. However, promoter hypermethylation increased significantly with age (p < 0.001 using regression analysis) and this was gender independent. We also showed that gene promoter methylation increased positively with an increase in waist to hip (WHR) ratio – the latter is also a known risk factor for colon cancer development.
Our study suggests that promoter gene hypermethylation of the MYOD-1 gene increases significantly with age in normal individuals and thus may offer potential as a putative biomarker for colorectal cancer.
MYOD-1; Colorectal cancer; Age; Promoter methylation
A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as “Raktarsha” - 11 & 7 ‘o’ clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.
Arshas; case report; Kshara karma; internal hemorrhoids; piles
In the title compound, C20H21NO2, the piperidine ring adopts a distorted boat conformation. The phenyl rings substituted at the 2- and 6-positions of the piperidine ring subtend angles of 86.0 (1) and 67.3 (1)° with the mean plane of the piperidine ring (all six non-H atoms). The crystal packing features C—H⋯O interactions.
It is well known that the electronic nose can be used to identify differences between human health and disease for a range of disorders. We present a pilot study to investigate if the electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry), can be used to identify and help inform the treatment pathway for patients receiving pelvic radiotherapy, which frequently causes gastrointestinal side-effects, severe in some. From a larger group, 23 radiotherapy patients were selected where half had the highest levels of toxicity and the others the lowest. Stool samples were obtained before and four weeks after radiotherapy and the volatiles and gases emitted analysed by both methods; these chemicals are products of fermentation caused by gut microflora. Principal component analysis of the electronic nose data and wavelet transform followed by Fisher discriminant analysis of FAIMS data indicated that it was possible to separate patients after treatment by their toxicity levels. More interestingly, differences were also identified in their pre-treatment samples. We believe these patterns arise from differences in gut microflora where some combinations of bacteria result to give this olfactory signature. In the future our approach may result in a technique that will help identify patients at “high risk” even before radiation treatment is started.
electronic nose; FAIMS; fermentome; gastrointestinal toxicity; gut permeability; pelvic radiotherapy
The molecular conformation of the title compound, C15H10ClN3, is stabilized by an intramolecular N—H⋯N hydrogen bond with an S(7) ring motif. The crystal packing is controlled by N—H⋯N and C—H⋯N intermolecular interactions. One of the methylene groups of the cyclohexene ring is disordered over two positions with refined occupancies of 0.457 (12) and 0.543 (12).
Molecules of the title compound, C21H16BrNO, are linked through pairs of N—H⋯O intermolecular hydrogen bonds into centrosymmetric R
2(10) dimers. One of the C atoms of the cyclohex-2-enone ring is disordered with refined occupancies of 0.61 (2) and 0.39 (2).
In the title compound, C16H13N3, the cyclohexene ring adopts a sofa conformation. An intramolecular N—H⋯N hydrogen bond generates an S(7) ring motif. In the crystal, the molecules are linked by pairs of N—H⋯N interactions, forming centrosymmetric dimers with an R
In the title compound, C17H12BrNOS, the cyclohexene ring deviates only slightly from planarity (r.m.s. deviation for non-H atoms = 0.047 Å). In the crystal, the molecules are linked into centrosymmetric R
2(10) dimers via pairs of N—H⋯O hydrogen bonds. The thiophene ring is disordered over two positions rotated by 180° and with a site-occupation factor of 0.843 (4) for the major occupied site.
Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency.
In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.
We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.
In the title compound, C11H9ClN4OS2, the thiadiazole and chlorophenyl rings are oriented at an angle of 43.1 (1)°. The sum of the bond angles around the amide N atom (359.8°) of the acetohydrazide group is in accordance with a model of sp2 hybridization. In the crystal, inversion dimers linked by pairs of N—H⋯O hydrogen bonds generate R
2(8) loops. Weak C—H⋯π interactions also occur.
Purification, crystallization and preliminary X-ray analysis of haemoglobin from ostrich (Struthio camelus) has been carried out under 293 K temperature conditions. The ostrich is a large flightless bird which contains inositol tetrakisphosphate in erythrocytes and its whole blood oxygen affinity is higher. Efforts have been made to explore the structure–function relationship of ostrich heamoglobin.
Haemoglobin is a tetrameric protein that carries oxygen from the lungs to tissues and carbon dioxide from tissues back to the lungs. The oxygen-binding properties of haemoglobin are regulated through the binding of allosteric effectors. The respiratory system of avian species is unique and complex in nature when compared with that of mammals. In avian species, inositol pentaphosphate (inositol-P5) is present in the erythrocytes of the adult and is thought to be the major factor responsible for the relatively high oxygen affinity of the whole blood. The ostrich (Struthio camelus) is a large flightless bird which contains inositol tetrakisphosphate (inositol-P4) in its erythrocytes and its whole blood oxygen affinity is higher. Efforts have been made to explore the structure–function relationship of ostrich haemoglobin. Ostrich haemoglobin was purified using ion-exchange chromatography. Haemoglobin crystals were grown by the hanging-drop vapour-diffusion method using PEG 3350 as the precipitant in 50 mM phosphate buffer pH 7.2. Data were collected using a MAR345 image-plate detector system. The crystals of ostrich haemoglobin diffracted to 2.2 Å resolution. They belonged to the orthorhombic space group P212121 with one whole biological molecule in the asymmetric unit; the unit-cell parameters were a = 80.93, b = 81.68, c = 102.05 Å.
haemoglobin; Struthio camelus
We assessed referral patterns of children with hematological malignancies (HM) in North India.
Materials and Methods:
The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptom-diagnosis), and number of contacts were compared between high- and standard-risk disease group.
Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1–6), 37 days (IQR 13–55), and 38 days (IQR 15–60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay.
Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective.
Childhood cancer; epidemiology; patient delay; referral delay
Ligands of Peroxisome proliferator-activated receptor gamma (PPARγ) can inhibit growth and promote apoptosis in various cancer cells, and thus have the potential to be utilized as anticancer drugs. This potential however, has been seriously challenged by observations that they can lead to tumor promotion in some cancer models, possibly due to activation of different signaling mechanisms in various tumor environments. Elucidation of the specific signaling events that modulate PPARγ ligand-mediated events is thus critical to increase their efficacy. The studies described here were designed to elucidate the signaling pathway(s) that modulate the apoptotic potential of Troglitazone (TRG), an artificial PPARγ ligand in hepatocellular carcinoma (HCC) cells.
Our results indicate that the apoptotic potential of TRG was regulated by the presence or absence of serum in the media. When added in serum-containing media, TRG inhibited proliferation and cyclin D1 expression, but was unable to induce any apoptosis. However, TRG's apoptotic potential was induced significantly when added in serum deficient media, as indicated by increased PARP and Caspase-3 cleavage and results from apoptosis assay. Furthermore, TRG-induced apoptosis in serum deficient media was associated with a dramatic reduction in PI3Kinase downstream target AktSer473 and FoxO1Thr24/FoxO3aThr32 phosphorylation. On the contrary, there was an increase of PI3K-induced AktSer473 and FoxO1Thr24/FoxO3aThr32 phosphorylation involving Pak, when TRG was added in serum-containing media. Pharmacological inhibition of PI3Kinase pathway with LY294002 inhibited Aktser473 phosphorylation and sensitized cells towards apoptosis in the presence of serum, indicating the involvement of PI3K in apoptosis resistance. Interestingly, pharmacological inhibition or siRNA-mediated knockdown of Akt or inhibition of Pak was unable to sensitize cells towards TRG-induced apoptosis in the presence of serum. Similarly, TRG was unable to induce apoptosis in the Akt1-KO, Akt1&2-KO MEFs in serum-containing media.
These studies indicate that TRG-induced apoptosis is modulated by PI3K pathway in a novel Akt-independent manner, which might contribute to its tumor promoting effects. Since PI3K activation is linked with various cancers, combination therapy utilizing TRG and PI3K inhibitors has the potential to not only increase the efficacy of TRG as a chemotherapeutic agent but also reduce its off target effects.
In the title compound, C15H11N3, the cyclohexene ring adopts a sofa conformation. An intramolecular N—H⋯N hydrogen bond generates an S(7) ring motif. In the crystal, molecules are linked by intermolecular N—H⋯N, C—H⋯N and C—H⋯π interactions into a three-dimensional network.
In the title compound, C11H9NO2, the quinoline ring system is essentially planar (r.m.s. deviation = 0.005 Å) and the methoxy and aldehyde groups are almost coplanar with it [N—C—O—C = 6.24 (19) and O—C—C—C = 0.3 (2)°]. In the crystal, molecules are linked by pairs of C—H⋯O hydrogen bonds, forming centrosymmetric R
2(10) dimers. The dimers are linked via π–π interactions involving the pyridine and benzene rings [centroid–centroid distance = 3.639 (1) Å].
In the title compound, C5H7N2
−, there are two crystallographically independent cations and anions (A and B) in the asymmetric unit. In both picrate anions, one of the nitro groups lies in the plane of the benzene ring [r.m.s. deviations = 0.014 (2) and 0.014 (2) Å for anions A and B, respectively] and the other two are twisted away by 39.0 (2) and 18.8 (2)° in A, and 18.2 (1) and 2.5 (2)° in B. In the crystal, the cations and anions are linked by intermolecular N—H⋯O and C—H⋯O hydrogen bonds, forming a two-dimensional network.
In the title compound, C7H7NO·C6H3N3O7, one of the nitro groups of the picric acid molecule lies in the plane of the attached benzene ring [dihedral angle = 1.4 (1)°] while the other two are twisted away by 9.9 (1) and 30.3 (1)°. In the benzamide molecule, the amide group is almost coplanar with the benzene ring [dihedral angle = 4.4 (1)°]. An intramolecular O—H⋯O hydrogen bond generates an S6 ring motif. In the crystal, molecules are linked into a ribbon-like structure along the b axis by O—H⋯O and N—H⋯O intermolecular hydrogen bonds. In addition, C—H⋯O hydrogen bonds and short O⋯O contacts [2.828 (2) Å] are observed.
In the title compound, C19H19NO2, commonly called koenimbine, the pyran ring adopts a sofa conformation. The carbazole ring system is planar [r.m.s. deviation = 0.063 (1) Å]. A C(10) zigzag chain running along the b axis is formed through intermolecular C—H⋯O hydrogen bonds. The chains are linked via weak C—H⋯π and N—H⋯π interactions.
In the title compound, C21H21Cl3N2O2, the piperidine ring adopts a distorted boat conformation. One of the chlorophenyl rings is almost perpendicular to the best plane through piperidine ring, making a dihedral angle of 88.7 (1)°, whereas the other ring is twisted by 71.8 (1)°. The crystal packing is stabilized by intermolecular C—H⋯O, C—H⋯Cl and O—H⋯O interactions.
In the title compound, C20H21NO2, the piperidine ring adopts a distorted boat conformation. The dihedral angle between the two phenyl rings is 61.33 (18)°. In the crystal, intermolecular C—H⋯O interactions link the molecules into zigzag C(5) chains running parallel to .
In the title compound, C33H34N6O6, the dihydrobenzimidazol-2-one ring system is essentially planar (r.m.s. deviation = 0.021 Å). The cyclohexane ring adopts a chair conformation. In the 5-(biphenyl-2-yl)-2H-tetrazole fragment, the tetrazole ring is twisted away from the attached benzene ring by 35.73 (11)° and the two benzene rings form a dihedral angle of 68.00 (9)°. An intramolecular C—H⋯O interaction is observed. In the crystal, the molecules are linked into a zigzag chain running along the b axis by intermolecular N—H⋯O hydrogen bonds.